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General NPI Number Information
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NPI Number | 1427477470
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Entity Type | Individual
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Provider Name | MARY-ELLEN ADELE EDMISTON DO
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Gender | Female
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 1718 PATTERSON ST
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City | NASHVILLE
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State | TN
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Zip | 37203-2926
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Country | US
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Telephone | 615-963-4800
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Fax | 813-871-8184
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Provider Business Mailing Address
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Address Line | 1718 PATTERSON ST
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City | NASHVILLE
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State | TN
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Zip | 37203-2926
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Country | US
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Telephone | 615-963-4800
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Fax | 813-871-8184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 5916
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License Number State | TN
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